Evaluating resilience as a predictor of outcomes in lung transplant candidates

Abstract

Background Resilience represents the capacity to adapt to adversity. Resilience can improve following behavioral interventions. We examined lung transplant candidates’ resilience as a novel predictor using the Connor‐Davidson Resilience Scale (RISC‐10). Methods Waitlisted candidates at six centers were mailed questionnaires from 9/16/2015 to 10/1/2019. Follow‐up surveys were collected annually and post‐transplant. Outcomes were recorded through February 17, 2020. Primary outcome was pre‐transplant death/delisting. Analyses included t test or chi‐square for group comparisons, Pearson's correlation coefficients for strength of relationships, and Cox proportional‐hazard models to evaluate associations with outcomes, adjusting for age, sex, and mood. Results Participation was 55.3% (N = 199). Baseline RISC‐10 averaged 32.0 ± 5.6 and did not differ by demographics, primary transplant diagnosis, or disease severity markers. RISC‐10 did not correlate to the commonly utilized Psychosocial Assessment of Candidates for Transplant [PACT] or Stanford Integrated Psychosocial Assessment for Transplantation [SIPAT] tools. Scores < 26.3 (representing > 1 standard deviation below population average) occurred in 16% and were associated with pre‐transplant death or delisting, adjusted Hazard Ratio of 2.60 (95% Confidence Interval 1.23‐5.77; P = .01). Conclusion One in six lung candidates had low resilience, predicting increased pre‐transplant death/delisting. RISC‐10 did not correlate with PACT or SIPAT; resilience may represent a novel risk factor.

Single‐center experience with early liver transplantation for acute alcohol‐related hepatitis—Limitations of the SALT score and directions for future study

“…This raises the question of whether regular exercise and Few studies directly explore the relationship between resilience and transplant outcomes. However, available research suggests a positive association in both physical (e.g., decreased death and delisting in adult lung transplant candidates 9 ) and mental health domains (e.g., lower psychological distress in renal transplant recipients, 10 stability during healthcare transitions in adolescent kidney transplant recipients 11 ). Resilience is now an important area of research within addiction (independent of transplantation) and is linked to improved outcomes including decreased risk of relapse.…”

Solid organ transplant.

“…Active coping has been associated with better health outcomes and higher quality of life in TCs, and maladaptive coping, including avoidance and defensiveness, has been associated with nonadherence after SOT, worse mental health, poorer psychological adjustment, and lower quality of life among SOT candidates and recipients (Burker et al, 2005;Olbrisch et al, 2002;Pisanti et al, 2017;Sher & Maldonado, 2019;Swanson et al, 2018). In LGTCs, lower levels of resilience are associated with pretransplant death or delisting, and higher negative affect is associated with death on the waiting list (Bui et al, 2020;Pennington et al, 2020). Coping may be modifiable through psychological intervention, which may mitigate the risk for worse outcomes after SOT.…”

Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors

“…[28][29][30] The main variables of interest included psychological traits and concepts (Table 1), which we suspect have important implications for survivorship but have not been well described in the literature for LT recipients. These included PTG, [16,18,41,42] resilience, [13,15,43,44] role of God/religion in controlling one's health, [45,46] and positive coping traits such as active coping. [10][11][12]35,47] In addition, we investigated anxiety and depressive symptoms, which are well described in the LT population as relating to important outcomes including medication adherence.…”

“…[5][6][7][8][9] Other psychological concepts have been investigated to assess how individuals react, change, and adapt in response to stressful life events. These include coping style, [10][11][12] resilience, [13][14][15] and post-traumatic growth (PTG), [16][17][18][19] which have been suggested as important predictors of quality of life and health behaviors in other chronic diseases including LT recipients. These psychological concepts may influence post-transplant recovery by playing a role in active self-management [20] and selfefficacy (confidence) to perform various health behaviors.…”